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中华介入放射学电子杂志

中华介入放射学电子杂志 ›› 2017, Vol. 05 ›› Issue (04) : 249 -253. doi: 10.3877/cma.j.issn.2095-5782.2017.04.010

所属专题： 专题评论； 文献；

神经介入

复合手术室显微外科联合智能移动3D-DSA技术治疗脑动脉瘤的临床效果评价
黄文诺1, 甄勇2, 吕朋华1,†(), 王书祥1,†(), 孙陵1, 王福安1, 徐川1, 张勤3, 蔡明玉3, 耿素萍3   
  1. 1. 225001　江苏扬州，扬州大学临床医学院介入放射科
    2. 225001　江苏扬州，扬州大学临床医学院神经外科
    3. 225001　江苏扬州，扬州大学临床医学院介入诊疗中心
  • 收稿日期:2017-06-04 出版日期:2017-11-01
  • 通信作者: 吕朋华, 王书祥

Clinical efficacy of microsurgery in hybrid operation room combined with 3D-DSA technique in treatment of cerebral aneurysms

Wennuo Huang1, Yong Zhen2, Penghua Lyu1,†(), Shuxiang Wang1,†(), Ling Sun1, Fuan Wang1, Chuan Xu1, Qin Zhang3, Mingyu Cai3, Suping Geng3   

  1. 1. Department of Interventional Radiology, College of Clinical Medicine, Yangzhou University, Yangzhou 225001, China
    2. Department of Neurosurgery, College of Clinical Medicine, Yangzhou University, Yangzhou 225001, China
    3. Interventional Diagnosis and Treatment Center, College of Clinical Medicine, Yangzhou University, Yangzhou 225001, China
  • Received:2017-06-04 Published:2017-11-01
  • Corresponding author: Penghua Lyu, Shuxiang Wang
  • About author:
    Corresponding author: Lyu Penghua, Wang Shuxiang, Email:
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黄文诺, 甄勇, 吕朋华, 王书祥, 孙陵, 王福安, 徐川, 张勤, 蔡明玉, 耿素萍. 复合手术室显微外科联合智能移动3D-DSA技术治疗脑动脉瘤的临床效果评价[J]. 中华介入放射学电子杂志, 2017, 05(04): 249-253.

Wennuo Huang, Yong Zhen, Penghua Lyu, Shuxiang Wang, Ling Sun, Fuan Wang, Chuan Xu, Qin Zhang, Mingyu Cai, Suping Geng. Clinical efficacy of microsurgery in hybrid operation room combined with 3D-DSA technique in treatment of cerebral aneurysms[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2017, 05(04): 249-253.

目的：

探讨数字减影血管造影三维成像（3D-DSA）技术在复合手术室显微外科术中评价脑动脉瘤夹闭效果的应用价值。

方法：

分析2015年2月—2016年12月我院复合手术室采用显微外科技术夹闭的56例脑动脉瘤患者的临床资料，术中均行3D-DSA评价动脉瘤夹闭疗效。

结果：

56例患者中，43例（77%）3D-DSA显示动脉瘤瘤颈夹闭成功，载瘤动脉通畅。9例（16%）显示动脉瘤颈部残留，调整瘤夹后再次行3D-DSA，8例成功夹闭，1例显示轻度残留，未做进一步调整。4例（7%）载瘤动脉狭窄，调整瘤夹后行3D-DSA，2例存在轻度狭窄（均≤20%），未做调整。1例术后短期再次出血，家属放弃。随访6~12月，55例术后行脑血管造影未见动脉瘤复发及载瘤动脉闭塞。脑动脉瘤完全夹闭率达98.2%（55/56），载瘤动脉完全通畅率达96.4%（54/56）。

结论：

复合手术室3D-DSA技术可在三维空间准确评估术前脑动脉瘤形态及显微外科夹闭效果，对脑动脉瘤夹闭术具有重要指导作用。

关键词: 复合手术室, 脑动脉瘤, 数字减影血管造影三维成像
Objective:

To investigate the feasibility of microsurgery in hybrid operation room combined with 3D-DSA in treatment of cerebral aneurysms.

Methods:

Fifty-six patients with cerebral aneurysms from February 2015 to December 2016 were retrospectively analyzed. Microsurgery and intra-operation 3D-DSA were carried out in this study.

Results:

Among the 56 patients, 3D-DSA showed aneurysm neck clipping and patency of the aneurysm artery in 43 cases (77%) . The residual neck of aneurysm was seen in 9 cases (16%) . After adjusting the clip, 8 cases were successfully clamped, one showed slight residual and no further adjustment was made. Four cases (7%) showed parent artery stenosis. After aneurysm clip adjustment, 2 cases had mild stenosis (lower than 20%) , not adjusted. During the operation, 13 patients (23%) were adjusted by 3D-DSA. One case bled again shortly after the operation and family members gave up. Postoperative intracranial infection occurred in 1 case. During the following 6~12 months, 1 patients died. Cerebral angiography showed no aneurysm recurrence and patency of the aneurysm artery in 55 cases.

Conclusion:

The 3D-DSA technique in hybrid operation room can accurately evaluate the morphology and microsurgical clipping effect of the cerebral aneurysm in three-dimensional space, and plays great guidance role in the clipping of cerebral aneurysm.

Key words: Hybrid operation room, Cerebral aneurysm, 3D-DSA
图1 左侧后交通动脉瘤夹闭前后造影图
图2 交通动脉瘤夹闭前后造影图
图3 动脉瘤夹闭后运用穿刺导航进行颅内血肿引流
图4 前交通动脉瘤破裂后改行夹闭术后
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